Pfizer Consumer Healthcare, a division of Pfizer Inc., is voluntarily recalling one lot of Children’s Advil® Suspension Bubble Gum Flavored 4 FL OZ Bottle because of customer complaints that the dosage cup provided is marked in teaspoons and the instructions on the label are described in milliliters (mL).

Let’s take a closer look that. What that means is that if someone was paying attention to the number of units and not the units themselves (teaspoons vs. milliliters) — and why wouldn’t everyone expect consistency between the two? —that person could have given their child a significant overdose all the while thinking that they were following the directions.

That is putting it mildly. Since there are roughly 5 mL in a teaspoon, giving the smallest dose in teaspoons could result in administering a whopping 20 mL more than prescribed. For a 72-95 pound 11-year-old child, the error compounds to an overdose of 60 mL when only a 15 mL dose was intended!

It’s easy enough to make mistakes moving between U.S. customary and metric units without having organizations responsible for our over-the-counter medicines layering on their own errors that might be difficult to immediately perceive.

But changing to the metric system will cost money, I hear some cry

One of the pushbacks I’ve gotten over the years is that it would cost money to switch to the metric system. Let’s take a second and consider the cost of a recall such as the one cited here.

The bottom line: This recall of children’s medicine could have been completely avoided if we weren’t constantly juggling multiple measurement systems in this country.

I’m not saying that using one set of units would solve all problems. After all, it’s still possible a company could put out dosing instruction that contained a typo (or a host of other problems), but let’s do what we can to try to remove easily avoidable errors from the system.

Cost of a recall?

Based on some research I did, it sounds like an average recall cost is over $10 million dollars in direct costs (pulling product off the shelves, etc), while indirect costs (lawsuits, fines, and customer avoidance, stock price, harm to reputation) can mount for years after the recall.

That’s something to highlight when talking about using consistent measures and the cost to implement them.

This was really difficult to photograph since the units (cups and ounces on one side and milliliters on the other) are only embossed. Most measuring cups use ink for contrast. Hopefully, the visual complexity of one side compared with the other still comes across.

Every once in a while I come across something that really lives up to the cliché of “a picture is worth a thousand words.” I thought I’d share the images above with you since it relates directly to our lack of metric system adoption.

Most glass measuring cups are fairly cleanly designed to show U.S. customary units on one side (no, we don’t use the Imperial units we originally brought over with us from the U.K) and those of the metric system on the other side.

However, the one I recently bought really puts our awkward system into full light.

Interestingly, when I pointed my find out to the person at the cash register, she indicated that she wanted one as well. Alas, as I was shopping in a discount store, I had to inform her that I was buying the only one I saw. (Frankly, I was pleased that someone else wanted something that I considered a fairly unusual item.)

Keep in mind that the whole point of having liquid measuring cups is to avoid spilling whatever one wishes to measure. In theory, the volume-based measure of, say a cup that can be leveled off at the top containing dry ingredients, should be exactly the same as for a liquid measure. The only reason for a liquid measure is to prevent spilling once the measurement is made.

Americans have both “dry” and “wet” measuring cups is so, if you need a full cup of a liquid, you don’t spill it. A liquid measuring cup provides “slosh” margin above the full-cup measure. Also, liquids tend to level themselves. “Dry” cups makes it easy to push off any excess material and make it level. That’s why you don’t normally see half and quarter cup measures listed within dry measuring cups—you couldn’t level them. [Note the ml printed on the dry measuring cup.]

Once I decided to write a blog post about the measuring cup posted at the top of the page, I tried to do some more research to find out why the designer veered off toward visual complexity for something that is usually designed with simplicity in mind. Unfortunately, I was unable to find out much more from the paper price tag on the bottom of the cup, but it indicated that its origin was Turkey (even though, according to the U.S. Metric Association, Turkey adopted the metric system [or SI as it is known by most of the world] back in 1930. So apparently the cup was intended only for the U.S. market.

There was no identifiable marker’s mark other than something that looked to me like almost a ying and yang mark. A mystery to me, but if someone else can shed light on the maker so I can get some more background—preferably in English—I’d be happy to hear it.

I’ve been told (as in second-hand information) that many countries that have switched to the metric system don’t really need to teach fractions anymore because pretty much every fraction can be decimalized. Additionally, I’ve had first-hand conversations with middle school teachers and students who find teaching and learning fractions is a nightmare. Do we really need fractions or, once we switch to the metric system, can we just lay them aside? Over time, I’ve come to question that and here’s my current thinking…

Ultimately, a fraction is part of a thing

We will always need the concept of a less than a full measurement unit. Just as a pound cake was known for its ease because it was based on the ratio of a pound each of butter, sugar, eggs, and flour, it was pretty crude in terms its result. Whether we only need part of a measure of fabric or a piece of wood that is less than a meter long, it is important that children learn (and adults understand) the notion of something that is less than “one” of something.

A fraction has a built-in “math problem”

Maybe some of the resistance to fractions is the inherent idea that it is, as its heart, a “math problem.” (Would we think about things differently if they were called “math challenges” rather than “math problems”? Let’s see…) A fraction is a division “quest.” It can ask a practical question, as in “If I have a half a cup of flour left in this bag and I need a whole cup for my recipe, how much more do I need to borrow from my neighbor to get the full amount needed?” It is a division “question” that needs to be solved if we pair it with anything else (as in add, subtract, divide…).

Consider the following two math “dares”:

A traditional math “problem” on the left that includes fractions with uncommon denominators. On the right is the same math problem decimalized. The top number in the decimalized addition has only been carried two places to the decimal point, otherwise, it would go on forever.

When I hold up “flash cards” side by side with both types of problems shown above during my metric system demonstrations, almost invariably, people choose the one that has been decimalized because it eliminates the issue of uncommon denominators that are such a stumbling block for both children and adults. It also eliminates the steps to get to common denominators because all decimals already have common denominators in the form of 10s, 100s, 1,000s etc.

For the decimalized addition, just add up the columns as you would any math “action,” just making sure you keep track of where the decimal point goes in the final result. Pretty easy if the original equation is properly aligned as above.

In answer to the question “Can we get rid of fractions altogether?”

No. While most things will work just fine if you even go two or three numbers to the right of the decimal point, for some things it just won’t work since many decimals are frequently “rounded” and don’t fully express a numerical concept. While I am not a scientist, I do work with quite a few and when I posed the question of just decimals, “No” was the answer that came back to me. That’s because many fractions just don’t work as decimals for scientific formulas. Consider the fraction in the second math image. If you try to convert it to a decimal you have a problem because, technically, it trails on forever as in .3333333333333333333….

Scientists and mathematicians can’t work like that and need the compactness of fractions to visualize and express their work. (See the graphic at the top of this page for equation fractions.)

That said, let’s keep them where we really need them and stop needlessly torturing students, teachers and our population in general.

Even U.S. stock markets no longer report losses and gains with fractions down to the 16th. It changed a few years ago when the Securities and Exchange Commission ordered that all stock reports convert to the decimal system prior to April 9, 2001.

Why did it use fractions of quarters, eighths, halves, and sixteenths? According to the article from Investopedia, it dates back to the “pieces of eight” that Spain used some 400 years ago when it decided to exclude the thumbs for the purposes of counting…

I have previously written about how the Food Network’s popular chef Alton Brown has praised the ease of the metric system for kitchen use as far back as 2012 in my post called Not the End of the World:

It is impossible to measure these ingredients with consistent accuracy by avoir dupois—that is, volume. Heck, I’ve seen a cup of flour weigh anywhere from 3 to 6 ounces. If you want to measure flour, you have to do so by weight. End of story.
I’m Just Here For More Food, Alton Brown, p. 14.

But, bless his little Southern heart, in his latest book, Every Day Cook: This Time It’s Personal, he’s taken things a step further:

Despite the grumblings of my editor, I’ve decided to quantify these recipes the way I do in real life…For instance, I combine weights (metric no less) with standard volumetric measurements, that is, tablespoons, in the same recipe…However, when I do weigh, it’s always metric because…I hate fractions. I also hate working with decimal points, and that’s the nice thing about grams. No one ever says 18.4 grams unless they’re weighing out something that’s controlled either by local/state/federal laws or by international treaties. Now, I know that there of you who say food isn’t worth the trouble of purchasing a decent, multiformat digital scale with tare function (allows weights to be zeroed out), but you’d be flat-out wrong.

Of course, I could quibble with the fact that the metric system is based on mass rather than weight (weight varies by the gravity of the planet you happen to be on—mass is mass, regardless), but I suppose he could quibble back our scales actually go by a weight equivalent of mass—and I couldn’t prove him wrong.

There are lots of scales on the market. Pick one that catches your fancy to start with.

But here’s the important bit: not only is he urging cooks of various persuasions to buy and use a scale in their kitchens (you can’t consistently use the metric system without one, and very few people have a proper kitchen scale), but he also includes recipes that are based on metric units!!!!!!!

For instance, his recipe for Always Perfect Oatmeal includes 120 grams of rolled oats, 25 grams of quinoa, 475 grams of water and 7 grams of kosher salt. Yes, he does provide a couple of those ingredients with U.S. customary equivalents but for the quinoa and salt, he does not, thus forcing the use of a scale or a conversion. Where there are conversions, there will be conversion errors so hopefully those with the mistakes will see the error of their ways.

I urge you to take advantage of the coming holiday season to 1) buy lots of copies of Alton’s book for those you love; 2) and buy them a scale to go with it to get folks familiar with weighing things in the kitchen. Then, when we do convert to the metric system, more people will be ready. Tell you what, if this post gets more than 2,000 views before the end of the year, I’ll make a short video showing just how easy a scale is to use for cooking.

A couple of words about kitchen scales

Three years ago I wrote a post called Someone’s in the Kitchen with the Metric System where I extolled the benefits of using scales in the kitchen. While Alton said something about getting one for under $100 (yikes!), most of the ones I’ve bought for the kitchen and demos are between $10 and $15 each and—when I checked them against a calibration standard they do a respectable job all the way down to a gram.

In the post I put up a few years ago, I also pointed how there are some very cool scales you can get to present along with his book. Hardcover is currently $23.57 from Amazon. Throw in a scale for another $10 and you’re good to go. Buy a nifty scale like the one above and bump the package price up by an additional $20. Hey, do whatever best suits your gift-giving needs.

However, I do urge you to buy and use his book to support someone brave enough to include metric system units in an American-based cook book that also supports my work by getting people familiar with using scales in the kitchen. Every little bit helps and this is more than a little bit!

If I loved him before (and I did), I love him even more now.

Also, do let him (and his publishers) know that you support his use of metric system units through social media by using #EveryDayCook along with #USAgometric.

I recently received news that the Centers for Disease Control and Prevention (CDC) made a major conversion error relating to the metric system. The upshot is that it greatly underestimated the risk of formaldehyde in laminate flooring. The underlying mistake: it failed to convert between meters and feet initially reporting the estimated risk at one-third of what it should have been.

The organization did not come out and say lack of metric adoption was the cause of the error:

The CDC/ATSDR indoor air model used an incorrect value for ceiling height. As a result, the health risks were calculated using airborne concentration estimates about 3 times lower than they should have been.

However, others were more than happy to point out the real root of the problem:

There are some who believe that conversions are easy to make and therefore, living with two measurement systems shouldn’t be a problem.

Marciano’s book

In fact, in his book, Whatever happened to the metric system: How America kept its feet, John Bemelmans Marciano (Kindle location 2020 for both quotes), states:

Conversion is now as easy as speaking “seven ounces to grams” into your smartphone and immediately receiving the answer 198.446662g.

Marciano later goes on to say:

Why would Americans go metric when computers have done the job for them and they don’t even have to know about it?

How about a three times greater risk for potential negative health effects due to human unit-confusion error?

Luckily, the CDC was able to quickly make a correction but who knows how many other errors haven’t been caught and continue to put us at risk in one way or another?

The idea that technology will save us from conversion errors is flawed because it assumes that the human element won’t impose the error.

Surely the CDC has access to computers and other high-tech gadgets at least as good, if not better, than what I have access to in my smartphone and yet, the mistake was still made.

Again, it’s not a technology issue, it’s a human issue that will always occur even if the frequency of such mistakes is not currently well known.

Aside from outright errors, there’s the time it takes to make a conversion in the first place. Add up the time it takes to whip out the cell phone, ask the question, wait for the answer and read it. Then one needs to multiply that by how many people in this country need to do that in a year. All wasted time. One set of measures eliminates the entire issue.

I’ve previously pointed out people are already at risk every time their pharmacist converts a prescription written in milliliters (as they all are) into teaspoons and tablespoons. Why are we doing this to ourselves?

Ironically, the more skilled a user, the less attention they will pay to what ought to be routine outcomes, so the more likely these types of error will go unnoticed until they have untoward consequences. The reason is, as users become skilled, they automate actions, so their attention can be used more selectively; thus as they become more skilled, they pay less attention to the display, whose routine behaviour they have learnt to expect (Wickens & Hollands 2000).

A conversion “helper” from the 1970s

Still, we can learn from our past. One of the things I’ve heard from people regarding our last attempt at metric adoption in the 1970s (I was a bit young at the time to remember) was students were taught difficult and confusing conversion formulas.

Next time, just have people start using the new, metric system measures and convert only those things that are absolutely necessary. Fewer conversions means fewer errors.

I want to acknowledge how wonderful all the TED Active attendees and staff were. Given the TED philosophy of “Ideas worth spreading,” it’s not surprising that everyone I talked to about metric system adoption in the U.S. were either sympathetic (if not from the U.S.) or interested (if they were Americans). I met a lot of friendly and interesting people and hope to keep in touch with many of them.

Metric system observations in Canada

I hadn’t been to Canada for a long time (though I used to live across river from it when I grew up in Detroit) so I was curious what I’d see in person with my metric system radar on. My understanding was that Canada (like the U.K.) was a “soft adoption” county.

American company and dual labeling Don’t know that I’ve ever seen “liq” before. I’m told that it’s the French “onces liquides’ or fluid ounces.

In this case, soft adoption refers to countries that use solely metric units in some instances but both Imperial and metric units for other applications. It’s one of the reasons that the “Turn the UK Fully Metric Now” exists in Great Britan. Sure enough, on the bus ride up to Whistler, B.C. from Vancouver, B.C. I saw nothing but kilometer signs on the roads. However, I did make it a point to visit the little store near my hotel and snapped a couple of shots on my cell phone to confirm my suspicions about the use of both units. Yes, some food products had only metric mentions (or SI as it is known to the rest of the world for “Système International d’Unités ) but many items had dual labeling (plus French, of course).

Metric units steadily became normal for most products and services. However, certain areas of business did hold out against conversion, such as real estate.

As I related in a previous blog, when I had a phone interview with the head of the U.K. Metric Association, and I asked him why Britain wasn’t fully metric, his reply was along the lines of “Because you’re not.” That comment prompted my piece on how our country sets a bad international example.

Successes and failures

I found out a few weeks ago that I wasn’t accepted for the Women’s Salon for the TEDxABQ event but that didn’t stop me from applying for the big TEDxABQ event that will be held this fall. If I can get in, that would be great because it has an audience of about 2,000 people. I’ve had quite a few successes recently. Getting turned down for one presentation doesn’t faze me much these days.

As I wrote previously, TED Active certainly was. In fact, it was exhausting. With about 50 different talks during the week (starting as early as 8:15 a.m. and running through 7 p.m.) it was difficult to keep up. I’m fairly sure not everyone managed to catch every talk. A few days I ago I received a link to the unedited talks so I can watch the ones I missed.

Of course, the only picture I could find of myself in the Flickr feed has me resting my eyes. (Really, I remember this talk on extending human senses.)

On Tuesday (3/17) there was an opportunity to sign up for a fifteen-minute salon* on Thursday to either give a talk or curate* one. I really hadn’t intended on presenting anything myself but I went ahead and signed up. I wasn’t really sure what I was going to say, but I’ve given talks on our metric system problems before—just not to an international audience—and would need a different take on what message I wanted them to leave the presentation with.

Name badges (with photo) were scrupulously checked every time you entered the venue. They included a sensor that was read electronically.

Those who had signed up for the salons (there were five of us in all) received an email late Wednesday that if we wanted to have visuals, we needed to get them to the coordinator by 6 p.m. that evening. By the time I got back to my hotel room, I had about an hour to pull something together.

I was able to grab images I’d used for previous presentations, so I hurriedly pulled together nine slides including a cover slide titled: The United States and Metric System Adoption: What’s the Deal? I managed to submit them with 20 minutes to spare.

From then on, I skipped TED activities so I could rehearse for Thursday afternoon. (More than once I considered I must be nuts to present to people who been watching professionally-coached talks all week.) I had decided I’d talk for 10 minutes and then open it up to questions and comments. I really wanted to hear what people from other countries would have to say on the subject. I didn’t think I’d get a large audience since there were concurrent events taking place, however, I’d have a chance to answer a question I’d had for myself: “What could I say about why the United States wasn’t using the metric system?”

I’d designed the slides before I’d really had a chance to think about what I was going to say so I tried to pull together a cohesive message to go with the visuals. I knew I didn’t have time to get the presentation perfect but I decided to treat it like an audition for a TED talk so I kept at it. I knew the salon talks would be recorded and I might be able to leverage that if there weren’t any restrictions on use. (Oh, and as long as I did a halfway decent job.)

I was the first person to talk during the session and the audience had grown to about 30 people by the time I finished. My final slide was a call to action: If you’re American, please be aware of our situation and help us move toward metric adoption. If you’re not, please stop enabling us. If you are really worried about us “not getting” a weight or measure, don’t include our measures. Instead, use the metric measure and then tell us it’s “about the height of the Eiffel Tower,” or “about the weight of three medium apples,” and take away our crutch so we better realize we’re out of step. When I’d finished, the reception was quite warm.

There were three zones to watch the streaming TED talks, the auditorium (cell phones off) and area outside of the auditorium (where I spent most of my time) and the lobby where talking was allowed.

At the end of my presentation I did have time for questions. The first one I got was “How long did you think it would take to convert?” My answer, based on various things I’d seen over the years, was that five years was a reasonable time frame.

Another person mentioned the fact that we destroyed a Mars orbiter back in 1999 due to the confusion of two teams using both metric and U.S. customary measures. It literally crashed into the surface of the planet. I’ve updated the full costs associated with the mission and it comes close to a $1 billion dollar loss.

The peer review preliminary findings indicate that one team used English units (e.g., inches, feet and pounds) while the other used metric units for a key spacecraft operation. This information was critical to the maneuvers required to place the spacecraft in the proper Mars orbit.

I did specifically ask for feedback from someone who was in the audience for my whole talk. He told me he’d coached people for TEDx talks and the only thing he’d change was the visuals.

Allow me to present my main point upfront: we are endangering our health by not adopting the metric system in this country.

Doctors write prescriptions in metric units. Conversions (and potential errors) are made at the pharmacy.

Let me offer up a couple of examples that hopefully makes this clear. It’s important to understand that the medical field depends on metric units (as does most of science, for that matter). If healthcare workers talk in metric units and the public at large rely on U.S. customary units there is bound to be confusion and misunderstandings. That’s best avoided where your heath is concerned since the consequences could be dire.

Metric unit dosing is more precise

Last year Pediatrics (Official Journal of the American Academy of Pediatrics) published an article called “Unit of Measurement Used and Parent Medication Dosing Errors.”1 One of the article’s bottom lines:

Parents who used milliliter-only unit made fewer dosing errors than those who used teaspoon or tablespoon units. Moving to a milliliter-only standard could reduce confusion and decrease medication errors, especially for parents with low health literacy and non-English speakers.

While a minor mistake (whether too much or too little medication) might not make a huge difference for an otherwise healthy adult, these errors can be magnified for babies or those whose health is already compromised.

Most of our teaspoons and tablespoons are meant for eating, not dosing

No on should use “silverware” as substitutes for measuring teaspoons and tablespoons for medicine if they want to avoid dosing errors.

Another issue brought up in the piece was that the use of teaspoon and tablespoon employed for liquid medicines “may endorse kitchen spoon use.” I don’t know about you, but I have three sets of measuring spoons and many more spoons that I use for eating commonly referred to as “teaspoons” and “tablespoons.” The problem is, it’s the eating spoons that are often used to measure medicines. (Yes, I used to do that too, without even thinking about it.) If you have a dosing cup with only milliliters, the potential for confusion is greatly reduced.

As if that’s not bad enough

Even your actual measuring spoons aren’t as precise as you think they are. At one point I came across information indicating that up to a 20 percent variance is allowed. Again, that 20 percent could cause dosing errors. In researching this article I came across a page called “Cooking for Engineers” with the post:

I’ve got three sets of measuring spoons, and their measurements differ from each other, up to 1/4 teaspoon! Is there a way to know which (if any), are accurate?

The suggestions that followed involved scales and the temperature at which one should measure the water used to determine volume. Too bad no one suggested going metric.

Additional endorsement of the metric system for health reasons

I also have a document from the Institute for Safe Medication Practices (ISMP) called 2014-15 Targeted Medication Safety Best Practices for Hospitals2 . Two of its best practices mention sole use of metric system units.

Significant medication errors have occurred when the patients’ weight is documented in non-metric units of measure (e.g., pounds) and it has been confused with kilograms (or grams). Numerous mistakes have been reported when practitioners convert weights from one measurement system to another, or weigh a patient in pounds but accidently document the value as kilograms in the medical record, resulting in more than a two-fold error.

ISMP has received more than 50 reports of mix-ups between milliliter (mL) and household measures such as drops and teaspoonfuls, some leading to injuries requiring hospitalization.

Beware teaspoon and tablespoon instructions on prescriptions

Almost uniformly, prescriptions are written in metric units. However, if you pick up a liquid prescription and the dose on the bottle is not metric (and in reads teaspoon and tablespoons), the pharmacy has had to make a conversion. Where there are conversions, there is the potential for mistakes.

In addition, one of the top six recommendations in the 15th annual report of the National Coordinating Council for Medication Error Reporting and Prevention3 includes a “Statement of support for use of the metric system to dose medications.”

Advocate for the metric system and help make the country a healthy place!

To me, the most difficult part of the using the metric system day-to-day is getting used to the Celsius measure of temperature.

I changed the weather app on my phone more than a year ago so it’s much easier for me to use Celsius now, especially when you consider that 0° C is freezing. I know what freezing is, regardless of what system is employed. At the other end, 100° C is boiling instead of our 212° Fahrenheit. Since it’s slightly imprecise (compared to what we use now), some countries compensate by using decimal measures for temperature so it’s sometimes reported as 18.3° C, for example. (In Fahrenheit, 18° C could be anywhere between 64.4° to 66°. Okay granted, now that I look at that it looks pretty silly–the middle 60s are still the middle 60s. The decimal point doesn’t really help me decide how many clothes I should wear when I go outside…)

During my research for this documentary I found several rhymes to help people adjust to the “new” (at the time) metric measures. I used one of them during my previous presentation at the MidSchool Math conference last year but had to apologize since it hit me as a little clunky. I told my audience that I hadn’t had time to write something better.

I think it works because “pleasing” and “freezing” rhymes, “hot” and “cold” in the second and third lines shows a decreasing sense of temperature (as do the rest of the rhymes I came across).

Hey, you tell me. When the U.S. decides to convert to the metric system, which poem is the easiest to remember for you? I’ll leave the poll open a couple of weeks and will use the most popular version as I move forward with my project.

People say our customary units are easier…they’re wrong. They’re just more familiar.

In my last post I wrote about the class I’m taking to help learn how to raise capital for businesses. As part of the homework, some of us are trying to raise funds for our various projects. In a few cases, the full amount of money people are looking for is less than $2,000. In other cases, such as mine, it’s kind of a crash course in crowdfunding.

While my current estimated budget for the entire documentary is more than $200,000, for the class project I’m just asking for funding to help with my travel to Washington D.C. where the bulk of my interviews will take place. I’ve set up a separate bank account where the money will go (providing I at least meet my goal; it’s an all or nothing situation) once overhead and taxes are paid.

What my classmates are working on

While I’m putting my project first on the list, if my work doesn’t interest you, please feel free to take a look at the work of my fellow students. (It’s really a nice group of people, I must say. They could all use your support though the local ones would probably be of less interest.)